Sunday, August 13, 2006

We are killing ourselves

For the first time in generations children may again die younger than their parents. They eat too much, walk less and worry more, write Julie Robotham and Sherrill Nixon. Sydney Morning Herald

THINK of it as a vast experiment in human biology. Put millions of people in a limited space, then crank a few levers: increase the hours they work, and increase the distance they have to travel; tempt them with material goods but undermine their sense of security about the future; allow them almost unlimited access to food, but subtly direct their choice by making grease and sugar most accessible. See what happens.

The results are nearly in. Half a century of postwar growth - driven by escalating production, and flavoured by hard-core consumption and mass migration to cities - is yielding a consistent global pattern.

The population's physical health is starting to degrade. The body, overfed and under-exercised, stacks on weight; those extra kilograms turn on their owners, unlocking diabetes, kidney disease and cancers from a genome that evolved with little experience of carrying fat. Psychiatric illness increases as unbarred competition between individuals excludes and denigrates the more vulnerable.

Weight gain, says Dr Michael Booth, is a physical portrait of consumerism, an externalisation of our value system. "We do need to do something about 'I will give myself pleasure whenever and however I please and not think about the consequences,"' he says. "It's a problem that comes with greater and greater wealth. We see the world as the range of things available to us. Virtually anything is there for the taking. We've lost the notion that we should be denied anything."

Australia's various chronic health epidemics - obesity in particular - have been widely noted. Less frequently remarked is the degree to which they are just the logical conclusion of the lifestyle we have collectively adopted. Work, food, suburbs - the fundamentals of our lives - are no longer calibrated to be in harmony with the human body and soul, but have been relegated to afterthoughts in rampant economies as they lap one high-water mark after another.

And for now at least, there seems little chance of a radical rethink. "The intensity in terms of policy we need won't happen until we all know a teenager with type-2 diabetes who has just taken 20 years off their life," says Booth, who is the director of the NSW Centre for Overweight and Obesity.

He is as aware as anyone how real that prospect is. The centre's study this year of more than 5000 children for the NSW Government found 20 per cent of year 10 students had raised insulin levels, putting them at increased risk of the chronic and incurable disease. Among the heaviest boys, that figure was 68 per cent.

It has been said frequently that this generation of children may die younger than their parents as a result of their weight gain. But the phenomenon of children having the physiology of unhealthy adults is so new that no one can really predict the consequences.

The fat boom is not reflected in official life-expectancy projections - slated to increase for at least another half century.

The Australian Bureau of Statistics considers a man who reaches 50 in 2051 will live to an average 87 years, and a woman to 89. Those are improvements of six and 4.5 years respectively on the present crop of 50-year-olds.

What seems guaranteed - because it is happening already - is that more people will live with debilitating illnesses that will reduce their capacity to work and leach the enjoyment from those extra years.

Booth thinks it will take two generations to fix the sabotaging of our health. Australia is now making serious progress with reducing smoking rates, he points out, but that has taken 20 years. "I think this is a much harder problem than smoking. Everyone's affected. Everyone sits, everyone eats."

CITIES are hymns to hyper-consumption, and from this year, for the first time, more than half the world's population will live in one. But Australia is well ahead of that trend. Three-quarters of us live in cities, says the Australian Bureau of Statistics, and the urban population is gaining four times as many people annually as regional Australia. Sydney alone gains 30,000 residents a year.

The London of Charles Dickens, with its orphans and its garbage-sifters and debtors prisons, added citizens at a similar speed, trebling from 1 million to more than 3 million during the 1800s. More than a century later and in developed countries there is less explicit urban poverty, but by other measures the modern city may be at least as hostile to the striving human, and possibly more so.

"Cities are only there because they're supposed to be useful to people. When they start to have more negatives to people than positives you have to stop and think," says Pieta Laut, the executive director of the Public Health Association of Australia. "We can sustain human life in some of the cruddiest environments, and always have. We need to get beyond what we can survive in, but what's good for a community … cities will not become untenable but they'll get nastier and nastier."

People will need more resources just to survive, and more people will be marginalised if they cannot run fast enough to keep up, says Laut, who was a town planner before finding its solutions too simplistic. "Life is complex and highly integrated. That's why I find public health so interesting."

In some remote Aboriginal communities infection-related deafness is so commonplace that people affected do not believe themselves sick.

Affluent city dwellers may have to drive two hours every day just to maintain their standard of living, but they do not consider that an imposition on their wellbeing.

It is the dark side of the celebrated adaptability of the human species. "There is a slow deterioration in human health - and people learn to accept that," Laut says.

She is not talking about the few people who are too fat to walk. She means the rest of us who buy a takeaway and collapse in front of the TV because life is too exhausting to contemplate doing otherwise.

"Our health system will do better by everyone losing two to five kilos," she says, than more dramatic weight loss among the heaviest.

Twenty-five years ago, long before it was either fashionable or profitable, David Crawford spotted the first signs of the weight-gain trend. Though it was then much less extreme, Crawford - now the associate head of Deakin University's School of Exercise Nutrition and Sciences - saw the association between weight and heart disease in statistics compiled by the National Heart Foundation, and took a punt on its importance. He has been delving into the connection ever since, and has watched the epidemic unfold.

"There's something basically wrong with our lifestyles," Crawford says. Diabetes and obesity are woven into the fabric of dysfunction, but so are, "depression, social isolation, people dying alone in an apartment".

He is frustrated with the standard political response to the latest dire new health statistic: "TV campaigns with jingles. That's lovely but most [researchers] would say on its own it's not going to make a difference."

He would prefer serious, focused study into the uncharted territory of how individuals navigate the plethora of options in their lives, and how these choices play into the balancing act of keeping them healthy.

"One of the areas I think we need to look much more closely at is those groups in the community who are disadvantaged. The gap between them and the rest of the community is widening all the time," he says.

"Just because healthy foods are readily available and well priced, is that enough to persuade people to eat them? You can't stop to fill your car without someone offering you a chocolate bar. There's all this informal eating that happens anywhere and everywhere nearly all the time."

On the other side of the energy-balance equation, Crawford says: "We are engineering exercise out of our lives, and opportunities to sit still are becoming even more common: ride-on lawn-mowers, kettles that switch themselves off. You can sit still and live huge chunks of your life."

Even beyond the home and garden, opportunities for incremental exercise are eroding, for some people at least. How suburbs are designed strongly influences how people travel around them, and that in turn is an important determinant of residents' health.

The mass production of cars early last century allowed suburbs to sprawl in areas not served by public transport. That was rapidly followed by the rise of the shopping mall, usually built on a busy, main road; who needed corner shops, when you could jump in your car and drive to retail heaven?

That assumption perpetuated itself. For decades, town planners creating new suburbs did not bother with local shops or public transport because they figured everybody had a car. Suburb design started to take on the look of a rabbit warren, full of dead-end streets and winding roads, because people no longer needed to walk. Only now are planners returning to the more grid-like pattern of older suburbs that makes it easier for people to leave the car behind.

Professor Anthony Capon, a visiting fellow with the Australian National University's National Centre for Epidemiology and Population Health, says Australia's suburb design is not quite as bad as that of the United States, but it goes close.

"The motor vehicle is positive in some respects," says the former medical officer with Sydney West Area Health Service. "I drive a motor vehicle, it can be quite liberating. But it's like penicillin. There's a place for it, it isn't a magic bullet. There's a need for a balance between the motor vehicle, walking, cycling and mass transit."

But for the people Professor Christina Lee studies - women - the developing science of the suburbs may continue to miss the point.

Even the terminology of the debate is a poor fit with the reality of women's lives, says Lee, the head of the School of Psychology at the University of Queensland and an architect of the long-running Australian Longitudinal Study on Women's Health.

Transport researchers talk about "journeys" and whether they are on foot, by train or by car. But time-use studies show women make more generalised forays into the outside world. A trip to work probably also involves ferrying children to sport or music, picking up dry-cleaning and dropping off a library book. That means for many women there is no realistic way to travel without a car - removing another opportunity for the small bouts of activity that add up to sufficient exercise.

n last year's update from the study, the average woman in her late 20s had gained five kilograms in seven years - despite the fact that two-thirds had not yet had children. It is a rate that far outstrips the average for adults.

Young women also had the highest depression rates. Money worries are having a real, measurable effect on women's health, says Lee, as casual work, shift work and a culture of working longer than standard hours to prepare for a conference or to get an order to a client have all taken the predictability out of the working week.

"The time pressure associated with money pressure means people are more likely to be working long hours," she says. "They're working unpaid overtime because they're frightened of losing their jobs, and paid overtime because they need the money."

The result is less time for all people - but women in particular with their extra family commitments - to use at their discretion. And that translates directly into poorer health.

"Particularly with exercise it's very easy to get out of a pattern and very hard to get back into it," she says. When unencumbered time evaporates, wellbeing goes with it. "It becomes kind of normal that you feel a bit tired and like you're going to come down with flu."

For Lee, the solution to Australia's chronic health crisis has to go well beyond public transport, well beyond a redesign of what we eat, when and how, and engage head-on with critical questions of social policy: child care, gender roles, disadvantage, industrial relations.

"An individual woman's decision that she's going to lead a healthy life can only take you so far," she says. "Individuals make choices, but only in a social context. Urban design, workplace relations … the interaction between personal preferences and social structure has fallen through the cracks."

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